Electrophysiology is one of the fastest-growing subspecialties in cardiology, hospital leaders recently told Becker’s, as the demand for cardiovascular services grows in both the inpatient and outpatient spaces.
When Paari Dominic, MD, stepped into his role as director of electrophysiology at Iowa City, Iowa-based UI Health in 2023, three full-time electrophysiologists performed 900 procedures a year. In 2026, nine EPs — with three more joining in coming months — perform more than 3,200 procedures annually, a roughly 300% increase in three years that doesn’t include outreach cases. Patients still wait 60 to 90 days for a procedure.
“Part of what drove the growth at our main center wasn’t purely new patients — we simply didn’t have enough manpower before, so we had longer wait times and patients were backing up,” Dr. Dominic said. “Addressing that staffing gap is what allowed us to absorb all that volume.”
That volume is now spilling outside hospital walls. CMS has approved EP ablation procedures for the ASC setting, a shift a scientific statement published in the Journal of the American College of Cardiology described as positioning EP for the kind of site-of-care migration interventional cardiology underwent when CMS expanded ASC coverage for cardiac catheterization and percutaneous coronary intervention in 2020.
The numbers back up the comparison. Between 2018 and 2023, the number of single-specialty cardiology ASCs grew from 55 to 221 — about 4% of all Medicare-certified ASCs — and cardiovascular procedure volume in ASCs is projected to grow another 15% between 2023 and 2028. A KNG Health report for the Ambulatory Surgery Center Association projects cardiovascular ASC savings will grow from $390 million in 2025 to $1.57 billion in 2034, a 302% increase that would make it the fastest-growing procedure category in the analysis.
Cardiac catheterization currently accounts for just 0.2% of ASC procedure volume, compared with 18% for cataract surgery — the closest available model for what a fully matured site-of-care shift can look like at scale.
“We’re seeing a move toward utilizing electrophysiology procedures, including ablation and insertion of some devices, in freestanding centers,” Richard Chazal, MD, medical director of heart health at Lee Heart Institute in Fort Myers, Fla., told Becker’s. “Some of these procedures have matured to the point where many of these can, and perhaps should be, done in these lower-cost, efficient outpatient centers that can provide really good care.”
The push is also about access. Nearly half of U.S. counties don’t have a practicing cardiologist, according to a 2024 study in the Journal of the American College of Cardiology, and the shortage is worse in rural areas, where 86% of counties lack one — affecting 22 million Americans. Health systems are treating outpatient cardiology as a strategic priority rather than a response to policy pressure.
“[Outpatient cardiology] is something that we’re actively pursuing,” Dennis Butts, executive vice president and chief strategy and network development officer for Henry Ford Health, based in Detroit, told Becker’s. “It’s a key part of our strategy. It is something that we are proactively moving towards as a part of our affordability initiative, not something that we’re waiting for legislation to cause us or force us to be in that space.”
Physicians are already building the ownership model themselves. Amanda Ryan, DO, is an interventional cardiologist, CEO and owner of Advanced Heart and Vascular Center of New Mexico in Carlsbad, N.M., where patients previously traveled three to four hours for electrophysiology care. Dr. Ryan brought EP services in-house in 2025 through a dedicated six-month training program targeting atrial fibrillation and heart failure — though she’s candid about the margin pressure that comes with it.
“In the peripheral vascular and EP space, the revenue numbers can look high, but the costs are substantial,” Dr. Ryan told Becker’s. “You can find yourself in the negative on a case quickly if anything goes beyond routine. Even with standard equipment, you’re looking at profit margins around 15% — which is workable, but slim.”
Disposable device costs are a big part of that math. Ian Woollett, MD, an electrophysiologist with Sentara Medical Group in Virginia Beach, Va., built a workflow that replaces the imaging catheter long considered standard for atrial fibrillation ablation — which costs $2,000 to $3,500 per case — with a reusable probe instead. A feasibility study of 128 patients using the new approach recorded a 100% acute success rate with no major complications.
“We’ve kind of been sheltered from the direct effects of costs, because a lot of us work in hospital systems, and the margins for EP procedures have been so big, they’ve kind of been willing to eat the cost, and we’ve been blind to it,” Dr. Woollett told Becker’s.
Not every state is moving at the same pace. About half still have certificate-of-need laws that restrict complex cardiac interventions, and outfitting a single cardiovascular ASC procedure room can cost more than $1.5 million. But the buildout is already underway: New cardiac catheterization labs and cardiology-focused ASCs have opened or broken ground this year in states including Delaware, Virginia, Louisiana and Florida, part of a broader wave of investment in outpatient cardiac infrastructure.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
